Peritoneal carcinomatosis of colorectal cancer
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The incidence of peritoneal carcinomatosis of colorectal cancer amounts to 5%-15% for synchronous metastases and as much as 40% in cases of local recurrence. Despite significant advances in pharmacological treatment consisting in the introduction of targeted medications, prognoses for patients with peritoneal metastases are still unfavorable. Mean survival of these patients undergoing palliative treatment is in the range of 6-9 months; overall survival rarely exceeds 2 years upon extensive chemotherapy. Markedly better results are obtained for cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC). This treatment offers much better outcomes, leading to 5-year survival rates of as much as 30%-50%. The possibility to achieve such outcomes depends on the staging of peritoneal metastases as well as the completeness of macroscopic cytoreduction. The procedures require significant experience in abdominal surgery, are time-consuming (mean duration of the procedure ranging from 6 to 8 hours) and are burdened by complications that are due not only to the procedure itself but also to the intraperitoneal administration of the cytostatic drug at elevated temperature (41.5 °C). However, in patients with metastases limited to the peritoneum, the procedure is justified by its outcomes. At the same time, a combination of surgical cytoreduction with HIPEC followed by systemic chemotherapy offers a radical change in prognosis for patients hitherto qualified for palliative treatment only.
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